NCHN Blog

Leadership is the capacity to help transform a vision of the future into reality. The significant challenges we face today in healthcare require a form of leadership that is less authoritative and more collaborative.

I think most of us will be happy to see the arrival of Spring on Friday, March 20! I know I will be. After last month’s column where I was discussing Kentucky’s weather, we were hit with a second major snow storm on March 4-5. The Governor issued a state of emergency that lasted two days. Snow accumulation records were broken and if you happened to be watching the Weather Channel or national news, you probably heard about the hundreds of folks stranded on the interstates across the Commonwealth. Here at NCHN headquarters we had approximately 17 inches of snow! So, yes, so glad to see the longer days and warmer weather. Yesterday it reached 75 degrees. Nice!

I’ve heard the statement, from several parts of the country, “If you don’t like the weather (fill in the blank), just wait a day or two and it will change!” Managing a network is sometimes like dealing with changing weather. However, through your NCHN membership you have access to a number of tools and strategies to support you as you manage the challenges and changes facing your network.

For those of you that participated on the Informational Calls yesterday, you heard about two new programs available to help you support the healthcare delivery efforts of your members. The first call was offered by the National Rural Accountable Care Consortium and discussed “Pathway to Sustainability.” Doug Pollock, Regional Executive Director with NationalRuralACO shared information regarding HHS Secretary Burwell’s historical announcement of a CMS goal of having 30% of all Medicare provider payments be in alternative payment models that are tied to how well providers care for their patients, instead of how much care they provide, by 2016! And the second part of this goal is to have that percentage increase to 50% by 2018! A second goal is for virtually all Medicare fee-for-service payments to be tied to quality and value, at least 85% in 2016; and 90% in 2018. How could this be possible? CMS has 114 million dollars in grant funds available to assist rural communities make the transition to this new payment model. Mr. Pollock, summed up the announcement as follows, “Getting paid for population health is the key to your sustainability; community health systems are perfectly poised for success in population health programs; and ACOs are a good transitional program to optimize your delivery system for population health payment models – and if you join now CMS will pay for it.”

The second call was with Nancy Maher, Program Analyst, Office of Rural Health, U.S. Department of Veterans Affairs. Dr. Maher provided an update on the Veterans Access, Choice and Accountability Act of 2014 (VACAA) and spotlighted the Veterans Choice Program. This is a new program designed to assist the 22 million veterans living in the United States, of which 5.3 million or approximately 24% live in rural areas, more easily access health care closer to home. The “Veterans Choice Fund” has 10 billion dollars available to pay for non-VA provided care. The program sunsets in three (3) years or when the Veterans Choice Fund is exhausted. Network leaders that participated on the call reported already have some veterans enrolled in the program in their network services area. It was helpful that those members already involved in the program shared their experience with others on the call. Networks are assisting veterans obtain care closer to home. Additional information about the Veterans Choice Program can be accessed here. And for more information on how to become a Choice provider, click here.

The next NCHN Informational Call is scheduled for June 15 @ 2:00 PM ET. If you have any suggestions for topics or speakers, please let me know.

The Call for Nominations for NCHN Directors was distributed last week! We are looking for a few great network leaders to step up and serve your Association. Directors elected during this year’s election process will serve for three years, May 1, 2015 – April 30, 2018. If you have questions about eligibility requirements to serve as a Director or just questions in general, please feel free to email me or give me a call to discuss. Letters of interest are due by Friday, March 27 @ 12:00 PM ET. The ballot for elections will be distributed in mid-April.

Enjoy the warmer weather and longer days. Take time for yourself - take a walk, take in a spring sporting event, or just sit and listen to the birds sing.

This article was written by Christy Sullenberger, MS, Director of Member Services, and Rebecca J. Davis, Ph.D., Executive Director of NCHN, for the “Networking News” monthly newsletter. The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.

Evaluating the network organization or a specific network program is an essential element of performance and process improvement, as well as overall assessment of effectiveness. Evaluations are used to improve programs, build organizational capacity, demonstrate value, and provide a basis for decision-making. While there is no set method for network evaluation, an evaluation typically addresses inputs, processes, outputs, and outcomes. Each of these elements provides insight into a different aspect of the network organization. Taken together, evaluation is a useful tool for the network leader, Board, stakeholders, and present and future funders.

A well-executed evaluation will also provide a statement of value, which is notoriously difficult for many health networks. Historically, health networks can illustrate positive value and promising programs, but quality quantitative data is lacking. In order to provide a good illustration of a network program’s impact, and ultimately the value of the network an evaluation plan should be developed and executed. The process should begin by determining clearly stated and measurable goals for the program, define metrics (how will you measure the impact of project), collect data, analyze the data against program goals and objectives, and then illustrate the connection of the program’s outcomes to the network’s value.

An evaluation should show a direct link between the program activities and outcomes and should address a number of questions, including:

What do I need to know to make program decisions and adaptations?

What is working well and what is not?

How well does the program deliver value to members and stakeholders?

Potential funders, including private foundations and governmental agencies, are seeking justification for the investments they make in rural health networks. A good evaluation plan, along with previous outcomes, assists them in achieving this goal. A good example of the importance of evaluation to HRSA Rural Health Network Development Programs, is stated in a recent RFP Guidance,

“Evaluation is a very important component of the RHND Program. The collection of performance measures from past RHND cohorts and numerous rural health network case studies demonstrated positive outcomes. But, due to the lack of evidence and challenges using traditional quantitative methodologies to measure network outcomes, it is difficult to ascertain the significance and uniqueness of rural health networks that support positive health outcomes in rural communities. Project-level evaluations of RHND grantees will assist in determining and validating the reasons why rural health networks are an important strategy in the improvement of rural healthcare. A comprehensive evaluation approach should contain contextual, implementation and outcome evaluative components. And the process and result of evaluation should not only assist in the understanding of the benefits of rural health networks but be utilized in a manner that enhances and improves the functions and activities of the network.” (p.5, Rural Health Network Development Program Funding Opportunity Announcement, FY 2014, Health Resources and Services Administration, Office of Rural Health Policy (ORHP))

Rural Health Network Evaluation: When and How?

As part of your rural health network development grant proposal, you have already outlined program activities and expected outcomes. Prior to developing the proposal, you likely completed a needs assessment and know exactly what your vision is for the implemented project. You will now need to execute your evaluation plan. The evaluation approach you choose guides you in the collection and organization of data, so it is important to develop an evaluation plan early in the process of implementation. In addition, as you begin collecting data, you can conduct an ongoing evaluation, which determines if implementation is going as expected. This will lead to the final evaluation of the project and will determine if the stated objectives were met.

An evaluation may be goals-based, process-based (formative), outcomes-based (summative), or a combination of these. A goals-based evaluation determines whether you are meeting your overall objectives. A process-based evaluation addresses how your program works and highlights strengths and weaknesses. An outcomes-based evaluation addresses the benefits of your program to network members and/or the community. A final evaluation will often include pieces of all of these approaches.

Preparation

Before developing your evaluation plan, it is essential to sit down and re-summarize your proposed program’s activities and objectives. One common guideline for developing goals and objectives is the SMART acronym. All objectives should be Specific, Measurable, Attainable, Realistic, and Time bound. Ensure that you have a strong list of realistic goals, achievable objectives, and appropriate activities that link directly to the desired results. Consider the purpose of your evaluation, outline the specific questions that the evaluation will answer, and decide how and how often data will be collected. You may want to consider using a logic model to assist in planning (see more at The Logic Model). Once this template is developed, you can use it to identify specific metrics, determine the kind of data that you want to collect, and choose an evaluation approach that is appropriate to the project.

Evaluation Methods

There are a variety of evaluation methods and models. Each method has strengthens and weaknesses. The important question to answer, is which method will best provide actual data that can be used to determine the effectiveness of the proposed project. An evaluation plan for the proposed project may need to incorporate different approaches. Some basic methods of program evaluation include the following:

Questionnaires and surveys: can be analyzed and presented numerically/quantitatively

Interviews: provide primarily qualitative outcomes and can be conducted in person or on the phone and should be targeted and clear

Documentation review: can be inexpensive, but may not provide a complete picture

Focus groups: can provide a range of feedback, but may be slightly difficult to present analytically

Case studies: can provide an in-depth look at a program and many variables

The guiding principle in the selection of an evaluation method/s is to collect and present the most useful information about a program. Throughout the process, keep in mind that the method you choose will determine how the results are collected. And, in order to avoid introducing bias, you will need to develop a process that ensures that data is collected in the same way each and every time.

Common Components of an Evaluation Report

When you have identified your method/s and collected data, you will then need to communicate your findings. There are many ways to structure the evaluation, and organization and content will depend on your process and methodology, but the following is a common structure of an evaluation:

Title page

Table of contents

Executive summary

Purpose of the evaluation

Organization and program background

Overall evaluation goals

Methods used

Interpretations and conclusions

Recommendations

Appendices

For more detail on the above, see Contents of an Evaluation Plan. As you embark on your program evaluation and tie it into your network assessment, keep in mind that the most important element in the evaluation process is that you start early in the process of implementation and that you are consistent in your collection methods.

This article was written by Brendan L. Ashby, MBA, MPH, MCHES, FACHE, Dean of Health Sciences and Service Programs, Saint Paul College, for the “Networking News” monthly newsletter. The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.

Having been involved in the development and leadership of rural based healthcare networks in Minnesota and health workforce training in post-secondary academic institutions has shown me the importance of strategic planning. As network leaders, our charge is to assess the viability of the current or emerging network, gauge if the network is tactically positioned to meet its goals and objectives, and identify which strategic concerns and challenges warrant immediate leadership attention (Ashby, 2014). However, as important as strategic planning is, I have found it useful to adopt a mindset of strategic process that involves strategic thinking, acting, and learning that are just as important if not more important than any approach to strategic planning (Ashby, 2014). To help foster that mindset of strategic process, I want to share two of the tools that have helped my stakeholders and me-the Business Model Canvas and Strategy Change Cycle.

Business Model Canvas

When I was preparing for strategic planning sessions with my network, I wanted a novel approach and a colleague of mine suggested I try to develop business model canvases that she had effectively incorporated into her strategy sessions. The Business Model Canvas is a strategic tool developed by Alexander Osterwalder and Yves Pigneur as a way to visually capture and describe a network’s business model. I have had great success when using the business model canvas, especially when engaging reticent stakeholders that might have limited experience in any type of strategy planning or experts who appreciate the pragmatic framework. This unpretentious but powerful tool can demonstrate what is happening within a network and its value proposition in nine key areas:

Key activities: What are the most important activities that your network does or is planning to do?

Key resources: What resources are necessary for the network and its stakeholders to experience success?

Value proposition: What makes your network the best value for your stakeholders? Why would a patient, customer, or partner organization participate in your network’s services?

Costs: How many resources and types of resources does your network need to be sustainable and successful?

Customer relationships: How does your network establish and maintain relationships with your customer segments? On a one-to-one relationship, mass market, or niche? What are the costs of those relationships?

Revenue: How do you bring money into your network? Through grants, training, services, shared savings? What else?

Channels: How do you communicate with your stakeholders? Face to face meetings? Social media? Web conferencing? Printed materials? Think about all of the channels that your network currently uses or could use.

Using the business model canvas helps network participants to discover areas of strength, minimize network weaknesses, and potentially discover opportunities for additional funding and increasing services (businessmodelgeneration.com). For example, the business model canvas was an instrumental tool used in my former palliative care network to develop new relationships with other likeminded rural based healthcare systems across nine counties in northern Minnesota that resulted in increasing interdisciplinary training for health providers involved in palliative care, growing patient participation, and improving patient education. The business model canvas is an effective, interesting, and enjoyable method for network participants to begin to review their efforts from diverse perspectives.

Strategy Change Cycle

The Strategy Change Cycle developed by John M. Bryson can assist network leaders to figure out what the challenges are and provides ten steps to work through the strategic planning process. The strategy cycle will help network leaders think about your stakeholders and who needs to be part of the discussion; what details does the network leadership need and if you are missing any information; how you are going to implement this strategy process; if this is realistic; and lastly how can we create the highest enduring value for the people that your network serves (Ashby 2014).

The ten steps are as follows:

First your network leaders have to agree on the strategic planning process

Identify the network’s mandates

Review and gain understanding on the network’s mission and vision

Conduct a SWOT analysis

Discover the strategic issues facing the network

Frame tactics to address the challenges

Review and approve the strategic plan

Reaffirm alignment with the network’s vision

Foster a successful implementation process

Revaluate strategies and the strategic planning process

(Ashby, 2014).

The final steps of using both the Business Model Canvas and Strategy Change Cycle will occur when your network reassess your identified strategies and remember to be agile, change when necessary, and make corrections as needed. You need to constantly be thinking strategically. Remember, this is a process and not a one-time project. If you keep that in mind then you will be successful.

Welcome to winter. Wait, this is mid-February and we should be thinking about spring! But for most of the country as well, as here in Hardinsburg, Kentucky, we are in the middle of record snow falls, unusually low temperatures, forecast for even lower temperatures for the reminder of the week, and lots of shoveling in our future! Kind of reminds me of the network world – we think we are moving along and things are going smoothly and suddenly things change. Sometimes we have planned and are prepared for changes, but sometimes they catch us by surprise.

Last week on the ER Call for Network Leaders, Dr. Mary Kay Chess discussed Creativity & Innovation in new and growing networks,a very timely topic for the changing roles of health networks in today’s health care delivery system. Do you have the creativity and innovative spirit to refocus your network if faced with major changes? Have you thought about “innovation” and what it may mean to your organization? According to Dr. Chess and Oxford Dictionary, innovation is to make changes in something established, especially by introducing new methods, ideas, or products.

You will have the opportunity to participate in an exciting time for NCHN, as 2015 is an important milestone for your Association! NCHN will be celebrating its 20th birthday this year! I am happy to have been a part of such a growing, creative, and innovative organization since July 2006! I wonder if the founding members of NCHN, thought about what the Association would look like in 20 years? If they thought about what changes the organization would face and how creative and innovative the Directors and Officers, along with the membership would be to ensure the continuation of the Association?

During the recent move from Colorado to Kentucky, I had the opportunity to review files and rediscovered a folder that contained historical documents of the Association. Also, I looked for and found a slide presentation, “Celebrating 10 Years of Success with a Lot of Hard Work and Total Commitment!,” that Steve Ward, NCHN’s first president had prepared and sent me in the fall of 2006. Steve wanted to capture and share the history of the Association, but more importantly, he wanted the network leaders meeting in Nashville that fall to celebrate 10 years of working together to improve healthcare delivery in rural America.

According to Steve’s presentation, “Once upon a time … in the late 1980s hospital groups such as HCA, VHA, Quorum, and LHS were forming consolidated spheres of influence in the marketplace. Smaller hospitals such as community hospitals, rural health districts, private hospitals found themselves on the outside looking in.” Survival instinct takes over and Jan Bastian, Montana Health Network was featured as the leader of the pack!

As Steve continues to tell the NCHN story, “A new species forms! They are islands in the middle of somewhere!” Independent hospital networks begin to form – (and as you read the listing of those 10 hospital networks that were forming or were already formed in the 1980s, I know that you will be pleasantly surprised and glad to see some names you recognize that have given and continue to give so much to your Association over the years!) :

Great Plains Health Alliance, NY, John Osse;

Health Community Alliance, NY, Patricia Kota;

*Health Future, OR, John Meenahan;

**Montana Health Network, MT, Jan Bastian;

Northern Lake Health Consortium, MN, Terry Hill;

**Northland Healthcare Alliance, ND, Tim Cox;

**Rural Wisconsin Health Cooperative, WI, Tim Size;

*Sunflower Health Network, KS, Sheryl Dority;

*Synernet, Inc., ME, Bus Davis; and

*Western Healthcare Alliance, CO, Steve Ward.

*Continual NCHN membership; **Founding NCHN leader and still serving as network leader to their organizations!

The Beginnings of NCHN (according to Steve Ward’s presentation):

Those brave pioneers had never met each other and I still don’t know how they found each other! (Amazing, but also shows the creativity and innovation of health network leaders!)

The fact is, we needed support as we were the new breed of hospital network directors. We had to turn inward.

We met informally the first time in Minnesota in a Hilton Suite for two days behind locked doors.

The only rules, No Board Members allowed.

After all… we were going to speak about them behind their backs.

These directors continued to meet in concurrence with the NRHA (National Rural Health Association) meetings. There was much discussions of becoming a sub-group of NRHA.

Additional Directors of Health Alliances met in Chicago in 1995. At that meeting the decision was made that we should not be confused with or thought of as a political lobbying group.

In the Summer of 1995 By-laws for the organization were developed by a group of network Executive Directors led by Steve Ward.

On December 4, 1995, thirteen (13) network leaders met for the first official meeting of the National Cooperative of Health Networks (NCHN).

On December 5, 1995 the following network leaders signed the Certificate of Incorporation of the National Cooperative of Health Networks Association:

Twenty years later it is so very humbling, as well as exciting to see that all five organizations that provided the first leaders of NCHN are still organizational members of the Association! These founding members have continued to be creative, visionary leaders of the Association!

So now we ask you, as members, to give to NCHN! We are beginning to plan for a huge birthday celebration at our 2015 Annual Educational Conference, which will be held September 1-2 in Portland, OR. We are looking for members to volunteer to serve on both the Conference Planning Committee and a special 20 Years Celebration Committee. If you are interested in helping plan, coordinate, and provide on-site assistance at the 2015 Conference, please let me know.

History of NCHN will continue in March’s column. Until then, if you have any early documents, pictures, and/or members of early NCHN events, please share them with us. Christy will be collecting member stories of their involvement with NCHN over the past 20 years. We encourage you to share yours today!

NCHN is off to a great start! The 2015 NCHN Leadership Summit is finishing up today in Clearwater Beach, FL (photos from Monday are here). It has been a wonderful event, full of networking, meeting new colleagues, sharing of ideas, challenges and strategies. Jordan Tenenbaum, VP, Allevant developed by Mayo Clinic & Select Medical, kicked off the Summit with a motivational discussion, 6 Ideas of Brave Leadership: You are a Brave Rural Health Leader.

Jordan was certainly describing NCHN members, as we know you are a group of brave leaders. NCHN is here to support and strengthen your leadership development. During the first day of the Leadership Summit, Network Leaders have been busy networking, sharing their experiences, talking about projects and network activities, and getting to know their colleagues. Dr. Mary Kay Chess kicked off the 2015 Leadership Learning Community Program on Monday afternoon with a workshop on Key Milestones. The 60 participants enjoyed getting out in the Florida sunshine for the first part of Dr. Chess’ workshop and participating in some fun activities around exploring leadership. The outside activities ended with a scavenger hunt. The networking continued Monday night with a Taste of Florida Buffet on the beach and in addition to the delicious buffet, we were treated to a gorgeous sunset.

Tuesday morning, participants will continue the second part of the Key Milestones workshop and end the Summit with an update from the Federal Office of Rural Health Policy. The 36 HRSA Rural Health Network Development grantees, representing three HRSA programs have had the opportunity to interact with each other, as well as experienced NCHN members. I suspect each one of them will go home energized, with at least three new peers to connect with over the next few months, and will become braver in the leadership of their network. I look forward to hearing about the great work that will be occurring in networks across the country and am excited that NCHN serves as the connector to so many networks across the country. Welcome to 2015, we have blasted off this week for an exciting 2015! Next big NCHN event is the 2015 Rural Health Summit, which will be our Annual Educational Conference, September 1-2 in Portland, OR. Be sure to mark that date and watch for registration and hotel details in the near future.

The holidays, including the upcoming New Year are exciting times! For many of you, it may be the end of the fiscal year for your network. As you prepare for annual reporting to your board and members, I bet you are also thinking about what you want to do differently in 2015. No matter your reporting period, we all make resolutions of things we want to do differently, better, or more of in the new calendar year. While thinking about your reporting and resolutions, I hope that you make a resolution to take time to sit a spell, rest a bit during this hectic time of the year, and reflect on 2014.

This is my favorite chair to just sit and think! We have had this chair since around 1988. It came out of a barn in Nancy, KY and was in horrible condition. It is such a comfortable chair! Over the years, it has been reupholstered twice. One thing that makes it special. That is that I have a little stool that was Michael’s grandmother’s. We had that stool reupholstered the last time with the same fabric. By taking two older, non-related items and giving them both a face-lift, they became a pair and gave us a comfortable place to sit. Great place for thinking and planning for 2015. I hope each one of you have your own “thinking chair.” Please take the time to share a picture with us.

And talk about exciting, hectic times! It is the same here at NCHN’s headquarters. We are preparing for a major change, with a move from Montrose, Colorado back to Hardinsburg, Kentucky. Weather permitting, I will be driving in my little red car - with Ms. Millie - back to Kentucky during the last week of 2014. NCHN headquarters will reopen after the first of the year at its former location in Hardinsburg, KY. New year resolutions for me include getting the office set up and organized, hosting an exciting and fun Leadership Summit in Clearwater Beach, Florida next month, and continuing to provide support and resources to you and your network.

Enjoy this last issue of eNews for 2014! We look forward to hearing about your resolutions for new and continued projects, activities, and programming that you will be offering in 2015!

As we enter the holiday season, we recognize and appreciate how busy everyone is at this time of the year. To encourage you to stop and take care of yourself during over the next hectic weeks, our “Network Leadership Chair” for November is my new exercise ball chair! I ordered it online and it arrived on Friday. After assembling the chair base on Saturday morning, I noticed that the instructions said to inflate the exercise ball only to 80% and wait 24 hours to inflate to 100%. Being anxious to try it out, I didn’t want to wait 24 hours for that 100%, but my husband insisted. Sunday morning he decided that it really wasn’t inflated to 80%, so he added more air and said I had to wait another 24 hour before we took it to 100%. As I typed this article, he inflated it to the 100% and finished the assembly, but told me to wait until Tuesday morning before I tried it out!

As Network Leaders, sometimes we think we should immediately be at 100% with new projects, services, or activities. However, with this little project, I decided to follow the instructions and my husband’s encouragement and wait a few hours before jumping on the new chair. And while preparing the article, I found out that Christy has the exact same chair, except with a black ball. Since she has more experience in using the chair, if you have any questions, ask her, not me!

NCHN is happy to announce a new program, “Executive Round Table,” or as we are calling it “ER for Network Leaders.” Dr. Mary Kay Chess will be kicking off the new program on Tuesday, November 25 @ 11:00 AM ET, click here for more details. We are excited to launch this new service and look forward to the monthly lively discussions and especially the sharing! We all can learn so much from our peers. I encourage you to look at this time as “me” time, even maybe get yourself an exercise ball chair and join the calls. Or, as I’ve heard some members used to do on the Coffee/Tea Chats, walk on your treadmill while participating on the calls.

On Monday, NCHN hosted a TA call on the new HRSA Rural Health Network Development Planning Grant Guidance. Thanks so much to Amber Berrian, Project Officer for the Planning Program for taking the time to hold the discussion for NCHN members. For those of you that missed the call, a recording is available (details were included in the Save the Date). Also, Amber will be offering another TA call on the guidance on December 3. Some components of the new Guidance included an increase in the funding level from $85,000 to $100,000. The purpose of the Network Development Planning Grant program is to encourage the development of integrated healthcare networks. The application deadline is January 9, 2015 with an estimated start date of June 1, 2015. The project is for one year. One question that was asked about the program, was if existing networks could apply. This is discussed on Page 6 of the FOA, “…existing networks that seek to expand services or expand their service area are not eligible to apply. Existing networks that are proposing to collaborate with at least two (2) outside organizations that they have not worked with before under a formal relationship are eligible to apply.” I encourage NCHN members that are interested in exploring potential new projects, with new members, that have questions to contact Amber. I also encourage members that will be submitting applications, to do so early! Do not wait until January 9 to submit your application.

After the 2014 holiday season has ended, a great way to start 2015 would be attending the NCHN Leadership Summit, “Brave Leadership – Maximizing your Network’s Potential” will be held in Clearwater Beach, Florida, January 19-20, 2015. This is the premier leadership event for health network leaders. And, I stress, we want the Network Leader to attend, not network staff, not network members, not project managers, not CFOs, but the person that has the responsibility for the day to day management and operation of the network organization. We will provide additional information, including a near final agenda in the next eNews issue. However, registration is open and hotel reservations are being accepted. I encourage you to register early and make those hotel reservations today! The NCHN lodging rate is available January 17-22, based on availability of the hotel.

We wish you a wonderful Thanksgiving holiday, a safe Black Friday shopping experience, safe travels if traveling to visit family and friends, and encourage you to exercise and take care of yourself over the next few weeks!

So, I’m standing here at my desk, thinking about what to write for this month’s article, when I realize that no one sent me a network “chair story” since Mary Ann Watson’s response to the first article. This made me start wondering, if maybe a better article would be “Why do we need chairs?” Are we all sitting too much? I have received requests from NCHN members asking if I had any recommendations on treadmill workstations, etc. I had looked for such options, but decided that I would never be able to walk on a treadmill and type on the computer at the same time. If any of you have found such a model and it works for you, please share! I’m sure others would be interested.

According to an article I found on the Mayo Clinic website, researchers have linked sitting for long periods of time to a number of health concerns, such as obesity and metabolic syndrome. They report that too much siting also seems to increase the risk of death from cardiovascular disease and cancer. I recommend you take a few minutes to read the article, as they talk about how much time we all spend sitting at our desks and in our vehicles!

I started thinking, how much time during a normal work day do Network Leaders spend in their chairs and/or vehicles? I bet we all think probably not a lot – we are always on the move, meeting with our members, facilitating meetings, participating in calls, reaching out to potential new partners and the list goes on and on – but in reality, I bet we all sit a lot more than we realize. I know I do! And I decided to do something about it recently.

My adventure to find a way to stand more during the work day started at Office Depot. I purchased a rolling laptop cart, but it had to be assembled. When my husband got around to looking at it, he said he thought they had a better option at his office. A quick field trip to his office lead me to juststand.org. I needed something that would accommodate my laptop computer, a second screen, keyboard and mouse and have all these items connected, along with the printer and Internet cable. The rolling cart would have only allowed me to work on the laptop, while it was disconnected from my router. The employees in his office had these great workstations that had everything connected together. The product allowed them to easily move from sitting in their chair to standing and working effectively at their desk.

I purchase an Ergotron WorkFit-S, Dual Monitor Sit-Stand Workstation. We assembled and attached the work station to my antique oak desk. But, atlas, the laptop didn’t have a home! Follow-up to Amazon, netted an adaptor for the workstation that allows my laptop to set upon a perch that keeps it even with the second monitor. The overall fit to the antique desk is not perfect, but now I try to stand up more and sit less! I’m hoping that this change in my daily work environment will help reverse some of the medical factors I already have that are related to sitting too much.

Also, I'm thinking it will give my desk chair a break, as I noticed that it was kind of starting to slump to one side! This reminded me of a guy I worked with many years ago –he had sit in his chair for so long that it had distinctly conformed to his bottom! Others in the office would never bother his chair, as it didn’t feel right to anyone but him. Sometimes in networks that “conformed” condition can occur. If you retain a program and never make adjustments, update for the times, or evaluation – it may take on that feeling that it only works for certain members!

As we move from fall into the early winter months – let me know if you decide to try standing up more during the work day. If you find products that work for you, please share with me, so that we can share across NCHN. As Network Leaders, we should all be looking for ways to improve workplace productivity, which also improving our own health status and that of our members. Please join me in standing up on the job! And definitely send us photos of you doing so!

Chairs, Chairs, Chairs – we all use them every day! Did anyone besides Mary Ann Watson, Tennessee Rural Partners, think about the chairs in your network? Mary Ann said that she was going to propose a “chair inventory” around their network! I am curious to see if anyone else conducted a “chair inventory.” Did you find any programs in need of discarding, re-branding and/or reviving, or maybe even ready to be passed off to another organization to manage? Tell us about your chair inventory. If you didn’t see Mary Ann’s response to my article last month, you can read it here.

I must confess, I bought another chair. My plan with this series on Chairs and how they relate to Network Leadership was to start with the first chair I purchased, way back in the early 1970s! But then I bought this chair and thought, hmmm, maybe it makes more sense to start here and work backwards.

So, please meet my newest chair! See? It is a nice sturdy vintage oak rocker! Did I need it? No, but it was one of those deals that was just too good to pass up! I was at a live auction a couple of Saturdays ago and this chair, made by Grand Rapids Bookcase & Chair Company came up for sale. It reminded me of “mission oak” furniture and another similar, (non-rocker) chair I had bought in Virginia a few years ago. (And yes, I still have that chair.) So, when no one would bid on this rocker, I started it at $5.00. The auctioneer promptly got a $10.00 bid, but then no more bids seemed forthcoming. Could this antique oak rocker really sell for just $10.00? I just couldn’t image such a criminal thing happening to the chair, so I bid $15.00, thinking now someone else will surely see the value in this chair and continue bidding. Seems that no one else saw the value of the chair and I would become its new owner.

So, fast forward to later in the morning when Michael, my husband came back to check on me and how things were going and I introduced him to our new chair. First question, “Do we need this chair?” Of course not, but could I let it go for just a mere $10.00? I don’t think so! Do not worry, we will find a use for it or a new home. So far, it is still sitting just inside our front door. I haven’t found a home for it in our house and I'm still thinking about what I am going to do with this chair?!

This chair will represent “Durability” in our leadership series. It is durable, sturdy, heavy, well-constructed, dependable, and was very cost effective! Do you find yourself considering potential new programs or services for your network that seem like such a great value that you can’t pass them up? I bet you do. But will your members appreciate your great savings? Will they participate in the program or purchase the service from the network? Do you need a program or product that is similar to one you already have? Maybe you even have a few similar programs or products that members are not taking advantage of or currently using. If so, could a new program spark some interest?

Sometimes it just takes a little bit of a different look to get someone’s attention. Sometimes it can be something that your members are already familiar with, but maybe not used. Sometimes we just have to try another style of bringing services, products, or items to our members. In this eNews you will read about a new project that NCHN just released, our “Tools and Strategies for Managing Health Networks” website. We are so excited about this resource and thank all the members over the years that have answered questions, submitted examples and templates, and provided resources and support to their peers! Now you can find those items in one place.

Why don’t you pull up a chair and take a few minute and review the new site? And while you are doing so, let us know what you think. We would love some feedback on the website - what’s missing, what’s great, what would make it more usable, anything you can tell us to make the site the best resource for health networks – tell us.

Let us hear from you! Tell us about your newest “chair” (program). I’m sure other network leaders would like to know what their peers are doing and this is a great platform to share! Especially those of you that have received a recent HRSA grant. Tell us about the new program or service you will be launching.

And, by the way, would anyone be interested in a good vintage oak rocker? I have one looking for a home!